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The aim of the operative treatment of the hallux valgus deformity is to correct the medial luxation of the first metatarsal head out of the sesamoid complex, the restoration of a congruent joint, the patient after treatment should be painfree. 82 patients were available for an independent clinical and radiological review. The median follow up was 32 months. The evaluation of the results are based on objective and subjective assessment of the patients as well as on radiographic criteria, such as hallux valgus angle, intermetatarsal angle, shortening of the first metatarsal bone, subluxation, lateral positioning of the osteotomized MT I-head and position of the sesamoid complex. Depending on the degree of "lateralisation" of the sesamoid complex seven groups were defined: 0/0, 1/0, 1/1, 2/1, 2/2. 2/3, 3/3 following Appel. Following objective criteria 61% of the patients were evaluated excellent or good, following subjective criteria 77% were evaluated excellent or good. Isolated parallel shifting seems to be sufficient in mild forms of hallux valgus (sesamoid complex group 2/2 or less), while the severe subluxation in the metatarsophalangeal joint (sesamoid complex group 2/3, 3/3) requires an additional lateral wedge osteotomy.

At the present time, at least five different forms of viral hepatitis can be distinguished. The hepatitis A and E viruses are transmitted via a fecal-oral route, and are associated with poor hygiene. Hepatitis E is restricted to Central Africa, parts of Asia, and Central America. Hepatitis B, C and D are transmitted not via the fecal-oral route but, in the case of B and D mainly by sexual intercourse, and in the case of hepatitis C by infected blood products. Even after the introduction of interferon alpha, treatment possibilities are limited. Immune prophylaxis (hepatitis A and B) and general preventive measures are of considerable importance, not merely with respect to travelling.

The intestinal mucosa is the main barrier between a wide variety of potential antigens and human or animal beings. Beside of unspecific defense mechanisms there is a rather independently reacting gut associated lymphoid system (GALT), first described by Bienenstock. GALT is seen as part of a common mucosal immune system (MALT), the independency of which is based on morphological, functional and ontogenic reasons. The two main functional parts of GALT are Peyer's patches (with T-cells and B-cells) and the diffuse lymphoid tissue (DLT). The latter is found throughout the intestinal mucosa in two compartments, in the lamina propria and intraepithelially. However there is a network between different local immune systems and the humoral immune system which is demonstrated by the "homing" phenomenon of lymphocytes and "remote-site" stimulation. Although many basic mechanisms of intestinal immunity today are not completely understood, immunoprophylaxis against different enteropathogenic agents is successfully used either by active or by passive immunization methods.

Alpha interferon, administered at a dose of 1 to 3 million units three times a week over a period of 24 weeks, leads to normalization of the transaminases in about 50% of patients with chronic hepatitis C. About 50% of the initial responders experience a recurrent increase in transaminases (relapse). Thus, about 20% to 25% of chronic hepatitis C patients show a lasting response to treatment with alpha interferon. A better understanding of HCV replication and the effect of interferon might possibly lead to improvements in treatment resulting in a higher response and lower relapse rates. Side effects of alpha interferon are generally mild and reversible on termination of treatment. At present, alpha interferon cannot be recommended for asymptomatic patients or those with slowly progressive liver disease.

Different groups of patients were analysed for antibody to hepatitis-C-virus (anti-HCV). A high prevalence was found in individuals with parenteral exposure (chronic Non-A, Non-B hepatitis, 77.5%, drug addicts 84.5%), while blood donors had a prevalence of 0.51%, this was significantly higher in patients with chronic type B hepatitis (30%), in homosexuals (22.5%) and in patients with different types of autoimmune hepatitis (57.2%). This indicates that differential diagnosis of chronic hepatitis and indications for alpha interferon therapy is not possible by simply anti-HCV testing. Further studies are required to establish the diagnostic value of the anti-HCV test.

Acute fatty liver of pregnancy (AFLP) is a rare, but often fatal disorder in the third trimester of pregnancy. We report on a patient with AFLP complicated by acute hemorrhagic diathesis, who survived after early diagnosis and adequate treatment. On electronmicroscopy, the characteristic microvesicular fatty deposits in the centrolobular hepatocytes could be demonstrated.

Receptors for polymerized human serum albumin (R-pHSA) may play a role in the attachment of hepatitis B virus (HBV) to hepatocytes. Therefore, we evaluated the incidence and prognostic value of R-pHSA in acute hepatitis B virus infection. High titers of R-pHSA were found in 12/12 patients with HBeAg positive acute hepatitis B (log2-Titer: 8.5 +/- 1.5). Titers for R-pHSA and HBsAg correlated closely. Furthermore, R-pHSA occurred (log2-titer: 6.5 +/- 1.5) in 10/10 patients with HBeAg positive chronic active hepatitis B (CAH-B). In the course of HBV infection, R-pHSA were eliminated earlier than HBsAg. 4/20 patients which were asymptomatic HBsAg carriers had high titers of R-pHSA in correlation to the histological findings of CAH-B. Asymptomatic HBsAg carriers which were R-pHSA negative had a normal liver histology. R-pHSA were found to be an early prognostic marker in acute hepatitis B infection.

The investigations were aimed at detecting the impact of various cell separating techniques on the morphology and function of neutrophilic granulocytes. Methodically simple cell separating techniques were used, such as spontaneous sedimentation of ACD-AG blood and mechanically defibrinated blood and a flotation technique which makes use of cell isolation by means of a separating solution and centrifugation. Granulocytes which were isolated by the cell separator Haemonetics M 30 for therapeutic purposes and which, according to data in literature, are not damaged by cell separating techniques were used as reference cells. The electronic-optical evaluation of granulocyte morphology and the in vitro investigation of the phagocytic capacity for rice starch (ingestion rate) of differently isolated granulocytes were made after cell separation.

For more than two years, all HIV-positive women were seen in the Department of Obstetrics and Gynaecology in cooperation with the Department of Internal Medicine of the University of Mainz, for medical care and therapy, if necessary. Of 40 HIV-infected female patients who were treated, 25 women were followed up every three to six months. Most of the latter live in rural areas or outside the cities in the State Rhineland Palatinate, FRG. 52% of them are or were former intravenous drug abusers, and 44% had been infected by sexual transmission. Only one-third use condoms during intercourse, another third reject this kind of protection. The rest are without cohabitation for various reasons. 23 pregnancies are known in this group and in 20% of the cases HIV infection were discovered during prenatal care. Gynaecological and obstetrical findings are reported. 80% of the patients have had a recurrent candida infection of the vagina, which was detected by culture. Immunologically, 75% of the patients belong to stage III (according to the CDC classification). Out of this group, more than 50% show less than 400 CD4 (+) cells/microliters. A positive result for HIV-Ag, anti-p41 and negative anti-p24 was seen in five cases. One of the four patients with AIDS died of a rapidly growing cancer of the cervix.

At present, African swine fever (ASF) persists as an enzootic infection both on the African continent and in Europe (Portugal, Spain, and Sardinia). The recent outbreaks of ASF in Belgium and in the Netherlands have again demonstrated the threat of this disease to the swine population in Germany. The main reasons for this threat are the great tenacity of this virus and its stability in meat and meat products together with an immense tourism into these enzootic areas. Epizootiological peculiarities, such as virus replication in ticks and inapparent infections in wild boars are the reason why eradication of the disease has failed so far, especially when pigs are allowed to roam the countryside.

For evaluating the clinical effectiveness of thrombocyte substitution, the resonance thrombogram was registered before and after thrombocyte substitution in 50 patients with acute leukemia and the increase of thrombocytes (corrected increment) determined. Thrombocyte substitution led to a significant diminution of the platelet amplitude (p less than 0.01) and platelet value. The highest value of these alterations of parameters was reached 1 hour after transfusion, it was somewhat lower after 24 hours, yet the initial value was not reached again. Correlations could be found to exist between the platelet amplitude and the corrected thrombocyte increase 1 hour and 24 hours after transfusion. The resonance thrombography enables the successful control of thrombocyte substitution to be made and it is suitable for monitoring hemostasis in severe thrombocytopenia due to production.